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Abdel Al S. Chemotherapy extravasation injuries beyond the immediate stage: A series of 15 cases treated according to a preset surgical algorithm based on time of presentation. HAND SURGERY & REHABILITATION 2022; 41:391-399. [DOI: 10.1016/j.hansur.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 11/29/2022]
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Langer SW, Sehested M, Jensen PB. Anthracycline Extravasation: A Comprehensive Review of Experimental and Clinical Treatments. TUMORI JOURNAL 2018; 95:273-82. [DOI: 10.1177/030089160909500301] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An accidental extravasation of anthracycline-containing chemotherapy is a feared complication that may lead to necrosis and severe tissue destruction. For four decades, much effort has been done to prevent and treat this devastating condition. Savene™ has recently been proved to be very effective, and is the only approved treatment against anthracyline extravasation. It is thus now widely recommended. The present article represents a comprehensive review of, and historical insight to, the experimental and clinical studies of surgical and non-surgical treatments of extravasation during forty years of clinical anthracycline treatment.
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Affiliation(s)
- Seppo W Langer
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maxwell Sehested
- Experimental Pathology Unit, Copenhagen University Hospital, Biocentre, Copenhagen, Denmark
- TopoTarget A/S, Symbion Science Park, DK-2100 Copenhagen, Denmark
| | - Peter Buhl Jensen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- TopoTarget A/S, Symbion Science Park, DK-2100 Copenhagen, Denmark
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Worst T, Sautter L, John A, Weiss C, Häcker A, Heinzelbecker J. Cisplatin-Based Chemotherapy for Testicular Germ Cell Tumors: Complication Rates of Peripheral versus Central Venous Administration. Urol Int 2015; 96:177-82. [PMID: 26681435 DOI: 10.1159/000442003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 10/28/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Despite the low local toxicity of the used agents, Cisplatin-based chemotherapy (CBP) for patients with testicular germ cell tumors (TGCT) is mostly delivered via a central venous access (CVA). Since 2008, CBP is given peripherally in our hospital. METHODS Medical reports of TGCT patients who received CBP between September 1991 and August 2014 were evaluated. Complications regarding the way of administration (CVA vs. peripheral venous catheter [PVC]) were classified according to the Common Terminology Criteria of Adverse Events. The complication rates were compared using chi square test and propensity score matching. RESULTS During 288 cycles in 109 patients, 85 complications (29.5%) were observed with similar rates for overall (PVC 31.3%, CVA 29.9%; p = 0.820) and grade I complications (21.3%, 25.4%; p = 0.470). More grade II complications were observed in the PVC group (10.0 vs. 1.5%; p < 0.001). Grade III complications requiring invasive treatment were found only in the CVA group (3.0%; p = 0.120). Using propensity score matching, no differences in overall (p = 0.950), grade I (p = 0.540) and grades II/III (p = 0.590) complications were seen. CONCLUSION The peripheral and central administration of CBP has similar overall complication rates. Despite more grade II complications, the peripheral administration of CBP is a safe alternative for TGCT patients. Additionally, no severe grade III complications occurred.
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Affiliation(s)
- Thomas Worst
- Department of Urology, Mannheim Medical Center, University of Heidelberg, Mannheim, Germany
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Abstract
For more than half a century, the different properties of dexrazoxane have captured the attention of scientists and clinicians. Presently, dexrazoxane is licensed in many parts of the world for two different indications: prevention of cardiotoxicity from anthracycline-based chemotherapy, and prevention of tissue injuries after extravasation of anthracyclines. This article reviews the historical, preclinical, and clinical background for the use of dexrazoxane for these indications.
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Affiliation(s)
- Seppo W Langer
- Thoracic and Neuroendocrine Section, Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
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Subcutaneous wash-out procedure (SWOP) for the treatment of chemotherapeutic extravasations. J Plast Reconstr Aesthet Surg 2011; 64:240-7. [DOI: 10.1016/j.bjps.2010.04.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 04/21/2010] [Accepted: 04/23/2010] [Indexed: 11/20/2022]
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Dionyssiou D, Chantes A, Gravvanis A, Demiri E. The wash-out technique in the management of delayed presentations of extravasation injuries. J Hand Surg Eur Vol 2011; 36:66-9. [PMID: 20682583 DOI: 10.1177/1753193410379553] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Late presentation of extravasation injuries from chemotherapeutic agents is not uncommon. Twenty-four patients with extravasation injuries presented with upper limb extravasation but without any skin necrosis between the second and the fourteenth day following injury day. We flushed out the infiltrated area with 300-500 ml of normal saline through multiple stab incisions. All 24 patients responded well to the procedure and no further complications occurred. The average time for the complete healing of the wounds was 15 days. All the patients were able to continue their chemotherapy treatment without delay. Patients were followed up for a mean period of 13 months. They all recovered with no functional deficit and only mild scarring. Early recognition and immediate treatment of extravasation injuries are of paramount importance. In cases with no evidence of skin necrosis, a delayed wash-out procedure appears to be very effective in removing the extravasated drug and minimizing further tissue damage.
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Affiliation(s)
- D Dionyssiou
- Medical School, Aristotle University of Thessaloniki, Department of Plastic Surgery, Papageorgiou Hospital of Thessaloniki, Thessaloniki, Greece
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Abstract
Extravasation of chemotherapy is a feared complication of anticancer therapy. The accidental leakage of cytostatic agents into the perivascular tissues may have devastating short-term and long-term consequences for patients. In recent years, the increased focus on chemotherapy extravasation has led to the development of international guidelines that have proven useful tools in daily clinical practice. Moreover, the tissue destruction in one of the most dreaded types of extravasation (ie, anthracycline extravasation) now can effectively be prevented with a specific antidote, dexrazoxane.
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Affiliation(s)
- Seppo W Langer
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark.
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D'Andrea F, Onesti MG, Nicoletti GF, Grella E, Renzi LF, Spalvieri C, Scuderi N. Surgical treatment of ulcers caused by extravasation of cytotoxic drugs. ACTA ACUST UNITED AC 2009; 38:288-92. [PMID: 15513601 DOI: 10.1080/02844310410027383] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite preventive measures, the extravasation of cytotoxic drugs still occurs in 0.6% to 6% of cases. The aetiology is thought to be that tissue necrosis develops into a chronic ulcer, which causes problems if the harmful action of the drug is not blocked. From 1988-2002 at the Department of Plastic Surgery of Rome University "La Sapienza", 240 patients presented with extravasation of cytotoxic drugs; all had been treated with an original conservative protocol first described in 1994, based on the repeated local infiltration of a large quantity of saline solution (90-540 ml) into the area of extravasation. We considered only cases with actively necrotic lesions. Eleven of the 240 patients (5%) had ulcers ranging from small ulcers to extensive areas of tissue necrosis. Of the 11 patients, eight had already had ulcers, while the remaining three were those in whom our conservative protocol had not prevented necrosis. They were all operated on and given grafts, local flaps, reverse radial flaps, and free flaps.
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Jordan K, Behlendorf T, Mueller F, Schmoll HJ. Anthracycline extravasation injuries: management with dexrazoxane. Ther Clin Risk Manag 2009; 5:361-6. [PMID: 19536310 PMCID: PMC2697522 DOI: 10.2147/tcrm.s3694] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The application of anthracyclines in anticancer therapy may result in accidental extravasation injury and can be a serious complication of their use. Tissue necrosis with skin ulceration is a possible outcome in the inadvertent extravasation of anthracyclines during intravenous administration. Until recently, there has been no effective treatment against the devastating effect of extravasated anthracycline. Preclinical and clinical studies are leading to the clinical implementation of dexrazoxane as the first and only proven antidote in anthracycline extravasation. In two multicenter studies dexrazoxane has proven to be highly effective in preventing skin necrosis and ulceration. This review focuses on the development and management of dexrazoxane in anthracycline extravasation injuries.
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Affiliation(s)
- Karin Jordan
- Clinic for Internal Medicine IV, Department for Oncology and Haematology, University Hospital Halle, Halle, Germany
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Kähler KC, Mustroph D, Hauschild A. Current recommendations for prevention and therapy of extravasation reactions in dermato-oncology. J Dtsch Dermatol Ges 2008; 7:21-8. [PMID: 18479476 DOI: 10.1111/j.1610-0387.2008.06752.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite the introduction of many targeted therapies, a wide variety of cytostatic agents are still frequently used in dermato-oncology. In order to avoid further morbidity in tumor patients, prevention of extravasation reactions is of highest importance. The optimal management of extravasation requires an early diagnosis, the application of specific antidotes and a well-trained oncology team.
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Mouridsen HT, Langer SW, Buter J, Eidtmann H, Rosti G, de Wit M, Knoblauch P, Rasmussen A, Dahlstrøm K, Jensen PB, Giaccone G. Treatment of anthracycline extravasation with Savene (dexrazoxane): results from two prospective clinical multicentre studies. Ann Oncol 2006; 18:546-50. [PMID: 17185744 DOI: 10.1093/annonc/mdl413] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the efficacy and tolerability of i.v. dexrazoxane [Savene (EU), Totect (US)] as acute antidote in biopsy-verified anthracycline extravasation. PATIENTS AND METHODS Two prospective, open-label, single-arm, multicentre studies in patients with anthracycline extravasation were carried out. Patients with fluorescence-positive tissue biopsies were treated with a 3-day schedule of i.v. dexrazoxane (1000, 1000, and 500 mg/m(2)) starting no later than 6 h after the incident. Patients were assessed for efficacy (the possible need for surgical resection) and toxicity during the treatment period and regularly for the next 3 months. RESULTS In 53 of 54 (98.2%) patients assessable for efficacy, the treatment prevented surgery-requiring necrosis. One patient (1.8%) required surgical debridement. Thirty-eight patients (71%) were able to continue their scheduled chemotherapy without postponement. Twenty-two patients (41%) experienced hospitalisation due to the extravasation. Mild pain (10 patients; 19%) and mild sensory disturbances (nine patients; 17%) were the most frequent sequelae. Haematologic toxicity was common as expected from the fact that the extravasation occurred during a chemotherapy course. Other toxic effects were transient elevation of alanine aminotransferases, nausea, and local pain at the dexrazoxane injection site. CONCLUSION Dexrazoxane proved to be an effective and well-tolerated acute treatment with only one out of 54 assessable patients requiring surgical resection (1.8%).
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Affiliation(s)
- H T Mouridsen
- Department of Oncology, Copenhagen University Hospital, Denmark
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Gulcelik MA, Dinc S, Dinc M, Yenidogan E, Ustun H, Renda N, Alagol H. Local granulocyte-macrophage colony-stimulating factor improves incisional wound healing in adriamycin-treated rats. Surg Today 2006; 36:47-51. [PMID: 16378193 DOI: 10.1007/s00595-005-3097-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2004] [Accepted: 01/18/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE Neoadjuvant treatment is often given for locally advanced malignancies; however, clinical and experimental studies have shown that some chemotherapeutic agents impair wound healing. It has been reported that granulocyte-macrophage colony-stimulating factor (GM-CSF) applied locally improves dermal wound healing. Thus, we investigated the effects of locally injected GM-CSF on abdominal wounds impaired by adriamycin, a widely used chemotherapeutic agent. METHODS We divided 120 female Sprague-Dawley rats into five treatment groups of 24 rats. Group 1 received saline 8 mg/kg intravenously (i.v.) + laparotomy 14 days later (control); group 2 received 8 mg/kg i.v. adriamycin + laparotomy 14 days later; group 3 received adriamycin 8 mg/kg i.v. + laparotomy + local GM-CSF 50 microg 14 days later; group 4 received saline 8 mg/kg i.v. + laparotomy + local GM-CSF 50 microg 14 days later; and group 5 received adriamycin 8 mg/kg i.v. + laparotomy + systemic GM-CSF 50 microg 14 days later. Sutures were removed on postoperative day (POD) 7 in all five groups, and the abdominal bursting pressures were measured and recorded. Tissue samples were taken from the incision line for histopathological evaluation and hydroxyproline content measurement. RESULTS The bursting pressure was significantly lower in groups 2 and 5 than in groups 1, 3, and 4. The hydroxyproline content and histopathological findings supported this result. CONCLUSION The local injection of GM-CSF improved impaired wound healing in adriamycin-treated rats.
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Affiliation(s)
- Mehmet Ali Gulcelik
- Department of General Surgery, Ankara Oncology Training and Research Hospital, Ankara, Turkey
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Nogler-Semenitz E, Mader I, Fürst-Weger P, Terkola R, Wassertheurer S, Giovanoli P, Mader RM. Paravasation von Zytostatika. Wien Klin Wochenschr 2004; 116:289-95. [PMID: 15237653 DOI: 10.1007/bf03040898] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A variety of antineoplastic agents is associated with toxicity to healthy tissue and therefore represents a hazard for patients in case of extravasation. The most common risk factors include patient associated and iatrogenic risk factors. Due to the possible complications after extravasation, the knowledge of these risk factors is the basis for prevention, which is of utmost importance. A classification of antineoplastic agents according to the type of tissue damage includes the categories vesicant, irritant, and non-vesicant. Dependent on the extravasated agent, a series of emergency measures should be considered, preferably adhering to a standard operation procedure. There is good evidence for the successful use of antidotes to some antineoplastic agents. These antidotes are dimethylsulfoxide or hyaluronidase, often combined with topical measures such as cooling or application of heat. The application of sodium bicarbonate, sodium thiosulfate, and heparin is not recommended, whereas the usefulness of corticosteroids is still a matter of controversial discussions. Ambiguity in the management of extravasation is often a consequence of limited clinical evidence. Due to our deficient knowledge about some of the administered cytotoxics, there is ongoing need for action even after decades of therapy with antineoplastic agents.
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Kennedy JG, Donahue JP, Hoang B, Boland PJ. Vesicant characteristics of oxaliplatin following antecubital extravasation. Clin Oncol (R Coll Radiol) 2003; 15:237-9. [PMID: 12924452 DOI: 10.1016/s0936-6555(02)00338-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Oxaliplatin is a novel class of platinum chermotherapeutic agent used in refractory adenocarcinoma. It has previously been regarded as a non-vesicant, and as such was considered safe to administer through peripheral veins. This report documents severe muscle and subcutaneous reaction with a single dose of oxaliplatin at the site of extravasation in a patient aged 58 years. Conventional therapeutic modalities were employed to reduce the effect of the soft tissue infiltrate. Despite that, significant muscle necrosis and fibrosis occurred. Surgery was deferred secondary to patient choice, and eventual extensive physical therapy restored function to the elbow joint. This case shows that oxaliplatin may not be an appropriate cytotoxic agent to be administered through a peripheral line and consideration must be made for central access when this drug is used. In addition, when extravasation does occur, the current report indicates that non-surgical management can be successful.
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Affiliation(s)
- J G Kennedy
- Department of Orthopaedic Surgery, Memorial Sloan Kettering Cancer Center, New York 10021, USA
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Heitmann C, Durmus C, Ingianni G. Surgical management after doxorubicin and epirubicin extravasation. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 1998; 23:666-8. [PMID: 9821616 DOI: 10.1016/s0266-7681(98)80024-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Doxorubicin and epirubicin are strong antineoplastic agents widely used in chemotherapy. One major complication of their use is skin sloughing after subcutaneous extravasation, the degree of which is often underestimated. Both drugs have a tendency to produce liquefying necrosis in soft tissue and chronic ulcers if extravasation occurs. Three cases of extravasation, their surgical treatment and final results are presented. In cases of doxorubicin and epirubicin extravasation it is very important to perform an early extensive surgical débridement with delayed closure to avoid long hospitalization and disabling results.
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Affiliation(s)
- C Heitmann
- Department of Plastic and Hand Surgery, Ferdinand Sauerbruch Klinikum, Wuppertal, Germany
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Bekerecioğlu M, Kutluhan A, Demirtaş I, Karaayvaz M. Prevention of adriamycin-induced skin necrosis with various free radical scavengers. J Surg Res 1998; 75:61-5. [PMID: 9614858 DOI: 10.1006/jsre.1997.5257] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Infiltration of antitumor agents into subcutaneous tissues may either result in a local area of self-resolving inflammation or progress to full-thickness loss of skin and underlying vital structures. Inadvertent extravasation of adriamycin can result in severe tissue necrosis. The mechanism of this tissue damage is believed to be release of oxygen free radicals into the tissue. After adriamycin extravasation, the treatment groups were made up according to drugs used, EGb 761, pentoxifylline, alpha-tocopherol acetate, and alpha-tocopherol succinate in rats. To prevent the necrosis and to decrease the tissue malondialdehyde levels, the most effective agent was found to be EGb 761, and pentoxifylline was also effective (P < 0.001). No difference was found between topical lanoline and saline (P > 0.05). The maximum ulcer diameter was obtained in 2 weeks. The maximum tissue malondialdehyde levels were obtained in 24 h, and in comparison to the control group the treatment groups showed lower levels. Our aim is to show the role of free radicals in the formation of skin necrosis as a cause of adriamycin extravasation and to prevent or decrease the skin necrosis using various free radical scavengers.
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Affiliation(s)
- M Bekerecioğlu
- Department of Plastic and Reconstructive Surgery, Yüzüncü Yil University, Medical School, Van, Turkey
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Abstract
Extravasation of certain cytotoxic agents during peripheral intravenous administration may cause severe local injuries. Most extravasation can be prevented with the systematic implementation of careful administration techniques. However, the management of this complication, the aim of which is to prevent progression to tissue necrosis and ulceration, remains an important challenge in the care of cancer patients. Many antidotes have been evaluated experimentally and a few may be able to reduce the local toxicity of the more common vesicant cytotoxic drugs. Because no randomised trial on the management of cytotoxic drug extravasation in humans has ever been completed, recommendations must be based on the more consistent experimental evidence and on cumulative clinical experience from available case reports and uncontrolled studies, which are reviewed in this article. Empirical guidelines recommend the use of topical dimethylsulfoxide (DMSO) and cooling after extravasation of anthracyclines or mitomycin, locally injected hyaluronidase after extravasation of vinca alkaloids, and locally injected sodium thiosulfate (sodium hyposulfite) after extravasation of chlormethine (mechlorethamine; mustine). Plastic surgery may be necessary when conservative treatment fails to prevent ulceration. The possibility of late local reactions must also be considered in the management of patients receiving chemotherapy.
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Affiliation(s)
- G Bertelli
- Department of Medical Oncology, National Institute for Cancer Research, Genoa, Italy
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Dini D, Forno G, Gozza A, Silvestro S, Bertelli G, Toma S, Filippi F, Passarelli B. Combined management in the treatment of epidoxorubicin extravasation. A case report. Support Care Cancer 1995; 3:150-2. [PMID: 7773583 DOI: 10.1007/bf00365857] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Inadvertent extravasation during intravenous antitumor therapy is not an unusual complication and can cause damage ranging from minor erythema to severe local necrosis. The appropriate management of these iatrogenic accidents as a part of supportive care in oncology has been addressed by several experimental studies, but there has been little clinical study and no conclusive evidence on the best therapeutic strategies to adopt. The case reported here of a patient suffering from severe soft-tissue injury caused by extravasation of epidoxorubicin demonstrates the usefulness of a combined management (medical, surgical and rehabilitative) in the appropriate care of extravasation.
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Affiliation(s)
- D Dini
- Cancer Rehabilitation Department, National Institute for Cancer Research, Genova, Italy
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Bertelli G, Dini D, Forno G, Gozza A, Venturini M, Ballella G, Rosso R. Dimethylsulphoxide and cooling after extravasation of antitumour agents. Lancet 1993; 341:1098-9. [PMID: 8096999 DOI: 10.1016/0140-6736(93)92462-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Andersson AP, Dahlstrøm KK. Clinical results after doxorubicin extravasation treated with excision guided by fluorescence microscopy. Eur J Cancer 1993; 29A:1712-4. [PMID: 8398299 DOI: 10.1016/0959-8049(93)90110-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Doxorubicin (DR) and epirubicin (ER) produce progressive tissue necrosis when extravasation occurs. Early detection and excision of all affected tissue is important. The clinical experience with fluorescence microscopic guided detection and excision in 24 patients is evaluated. 9 patients with fluorescence negative specimens were kept under observation without excision. None developed necrosis. Wide excision was performed on 15 patients with fluorescence positive specimens. Sequelae, defined as impaired function of the affected limb at the last control examination in the out-patient clinic, were observed in 8 patients. 4 of 5 patients with extravasation in the hand and 2 of 3 with extravasation in the cubital fossa were among these. Delay, defined as time from injury to surgery, was a median of 7 h, range from 3 h to 69 days. Patients developing sequelae had a median delay of roughly 4-fold that of patients without these complications. Patients with extravasation in the cubital fossa were hospitalised for the longest period: 30 days, range 24-45 days, vs. 12 days, range 7-80 days, for those with extravasation at other sites (P < 0.03). Our conclusions are: (1) fluorescence microscopic analysis is a reliable method for the detection and delineation of extravasation of DR or ER. (2) Do not use the cubital fossa or hand for the infusion of these cytostatics. (3) Act promptly if extravasation is suspected--delay leads to sequelae.
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Dahlstrøm KK, Chenoufi HL, Daugaard S. Fluorescence microscopic demonstration and demarcation of doxorubicin extravasation. Experimental and clinical studies. Cancer 1990; 65:1722-6. [PMID: 2317755 DOI: 10.1002/1097-0142(19900415)65:8<1722::aid-cncr2820650810>3.0.co;2-e] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Extravasation of doxorubicin and its derivative epirubicin, cause severe progressive tissue necrosis that requires early excision of all affected tissues. Doxorubicin and epirubicin are autofluorescent and this characteristic can be used to demonstrate and delineate extravasation by the aid of fluorescence microscopic study. In a rat model doxorubicin was injected intradermally in declining concentrations and the minimal detectable concentration was found to be 0.02 mg/ml. Skin necrosis developed in rats injected with doxorubicin concentrations ranging from 0.02 mg/ml to 2 mg/ml. Clinically, fluorescence microscopic analysis of frozen sections was used in eight patients to assess whether doxorubicin or epirubicin extravasation had taken place. When all fluorescing tissue was removed, no necrosis ensued, but in one patient, where a slightly fluorescing area was ignored, necrosis developed later and excision of the tissue had to be performed.
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Affiliation(s)
- K K Dahlstrøm
- Department of Reconstructive Surgery, Rigshospitalet, University of Copenhagen, Denmark
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Nettelblad H, Karlander LE, Nylander G. Pain relief after free flap reconstruction in adriamycin necrosis on the dorsum of the hand. A case report. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 1989; 14:45-6. [PMID: 2926221 DOI: 10.1016/0266-7681(89)90013-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A free flap transfer in a case of Adriamycin necrosis on the dorsum of the hand is reported. The advantages of this method of reconstruction are discussed.
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Affiliation(s)
- H Nettelblad
- Department of Plastic Surgery, Hand Surgery and Burns, University Hospital, Linköping, Sweden
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